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Description and evaluation of the rehabilitation programme for persons with lower limb amputations at Elangeni, Paarl, South Africa

Fredericks, Jerome P. (2012-03)

Thesis (MScMedSc)--Stellenbosch University, 2012.

Thesis

ENGLISH ABSTRACT: Lower limb amputations cause multiple physical, psychological, environmental and socioeconomic
barriers. Individuals who have suffered a lower limb amputation require
comprehensive rehabilitation to ensure social integration and economic self-sufficiency. In
addition, constant monitoring and evaluation is an essential part of human service delivery
programmes. However, the amputation rehabilitation programme offered at Elangeni an outpatient
rehabilitation centre for clients with physical disabilities in Paarl, Western Cape, South
Africa is not monitored, and has not been evaluated since its inception in 2000. Thus, the
current study evolved to describe and evaluate the rehabilitation programme for persons with
lower limb amputations at Elangeni.
A mixed method descriptive design was implemented. All persons who received
rehabilitation, after a major lower limb amputation at Elangeni, between 2000 to 2011, were
included in the study population. In addition, the physiotherapist and occupational therapist
that provided amputation rehabilitation at Elangeni, at the time of the study, were interviewed.
Thirty participants who met the study inclusion criteria were identified. Quantitative data was
collected using a researcher designed, structured demographic questionnaire, an
International Classification of Function checklist based questionnaire and a participant
rehabilitation folder audit form. Two interview schedules one for clients and one for therapists
were used for guidance during semi structured interviews. Quantitative data was entered
onto a spread sheet and analysed by a statistician using Statistica, version 8. Qualitative data
was thematically analysed according to predetermined themes.
No programme vision, mission or objectives could be identified for the amputation
rehabilitation programme. Poor record keeping practices and a lack of statistics were found.
Rehabilitation was impairment focused with no attention given to social integration. Clients
who received prosthetic rehabilitation showed improved functional ability with regard to
picking up objects from the floor (p = 0.031) getting up from the floor (p = 0.00069), getting
out of the house (p = 0.023), going up and down stairs with a handrail (p = 0.037) and moving
around in the yard (p = 0.0069), climbing stairs without a handrail (p = 0.037), going up and
down a kerb (p = 0.0082) walking or propelling a wheelchair more than 1km (0.0089) and
walking in inclement weather (0.017). A lack of indoor mobility training had a statistically significant negative impact on the
participants’ ability to lift and carry objects (p 0.011), standing up from sitting (p = 0.042),
getting around inside the house (p = 0.00023), picking up objects from the floor (p = 0.00068),
getting up from the floor (p = 0.0072), getting out of the house (p = 0.0016), going up and
down stairs with a handrail (p = 0.019), moving around in the yard (0.0013), going up and
down stairs with-out a hand-rail (p = 0.019), getting up and down a kerb (p = 0.0022), walking
or wheeling 1km or more (p = 0.0032) and using transport (p = 0.0034). Failure to address
community mobility during rehabilitation had a statistically significant negative impact on all
aspects of community mobility scores except doing transfers and driving.
In conclusion, for the study participants, Elangeni failed to provide rehabilitation according to
the social model of disability and Community Based Rehabilitation principles. It is
recommended that managers, service providers, and clients re-consider the purpose of
Elangeni and develop a vision and objectives for that service. In addition, management
should take an active role in service monitoring and evaluation and provide guidance and
mentorship to therapists.

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